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MedEd Lectures > Liver and Biliary > Flashcards

Liver and Biliary Flashcards

1
Q

List the types of Jaundice

A
  1. Pre-hepatic
  2. Liver jaundice
  3. Biliary Jaundice
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2
Q

What is pre-hepatic jaundice

A

Excessive amount of bilirubin presented to the liver due to excessive haemolysis

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3
Q

How is pre-hepatic jaundice detected in the serum

A

elevated unconjugated bilirubin in the serum

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4
Q

What hepatic jaundice

A

Impaired cellular uptake, defective conjugation or abnormal secretion of bilirubin by the liver cell

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5
Q

How is hepatic jaundice detected in the serum

A

Both conjugated and unconjugated bilirubin may be elevated in the serum

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6
Q

What is biliary jaundice

A

impaired excretion due to mechanical obstruction to bile flow

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7
Q

How is biliary jaundice detected in the serum

A

Elevated conjugated bilirubin in the serum

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8
Q

What are the effects of portal HTN

A
  1. oesophageal varices
  2. splenomegaly
  3. caput medusae
  4. ascites
  5. haemorrhoids
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9
Q

What are the effects of liver cell failure

A 
ABCDEFGHIJ
1. Asterixis (flapping tremor) 
2. Bruising 
3. Clubbing 
4. Dupuytren's contracture 
5. Erythema 
6. Fetor hepaticus (ketones and ammonia in the breath smells like freshly mown hay) 
7. Gynaecomastia 
8. Have portal hypertension 
9. Itching 
10. Jaundice 
spider naevi + testicular atrophy
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10
Q

What is hepatitis

A

inflammation of the liver

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11
Q

Which hepatitis viruses are transmitted through the faecal-oral root

A

Hepatitis A + E

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12
Q

Which hepatitis virus is transmitted by body fluids

A

Hepatitis B, C + D

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13
Q

What is the incubation period of a pathogen

A

the period between exposure to an infection and the appearance of the first symptoms.

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14
Q

State the incubation period, areas of high risk and risk factors for hepatitis A

A
  1. 2 weeks
  2. Africa/Asia
  3. poor hygiene
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15
Q

State the incubation period, areas of high risk and risk factors for hepatitis B

A
  1. 4-12 weeks
  2. Africa
  3. If you are a health worker
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16
Q

State the incubation period, areas of high risk and risk factors for hepatitis C

A
  1. 2 weeks to 6 months
  2. Eastern Mediterranean
  3. Injecting drugs
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17
Q

State the incubation period, areas of high risk and risk factors for hepatitis D

A
  1. 4-12 weeks
  2. Africa
  3. only co-infects with Hep B
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18
Q

State the incubation period, areas of high risk and risk factors for hepatitis E

A
  1. 5-6 weeks
  2. Poor water supply
  3. Immunocompromised patients
    and pregnant patients
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19
Q

Which 2 types of hepatitis’ are likely to be co-infected

A

Hep B + D

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20
Q

A patient has Hep D, which other infection do they have

A

Hep B

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21
Q

Which hepatitis is likely to be chronic in children

A

Hep B

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22
Q

Can Hep B be chronic

A

Likely in children

5% of adults

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23
Q

Which type of hepatitis is the most likely to be chronic

A

Hep C

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24
Q

Which types of hepatitis is mainly acute

A

Hep A, D + E

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25
Q

Viral hepatitis: what is the generic triad

A
  1. Fever
  2. Jaundice
  3. Raised AST/ALT
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26
Q

Which type of hepatitis is mainly asymptomatic

A

Hep C (in 80% of patients)

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27
Q

What is the first line investigation if you suspect viral hepatitis

A

Liver function tests

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28
Q

What is the gold standard (diagnostic) tool is you suspect viral hepatitis

A

Antibodies

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29
Q

What is the list of investigation you do if viral hepatitis is suspected

A
  1. Liver function test (first line)
  2. FBC
  3. U+Es
  4. Antibodies (diagnostic)
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30
Q

What is used to measure treatment response in viral hepatitis

A

NAAT (Nucleic Acid Amplification Test)

Test can indicate treatment response

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31
Q

What does HBsAg suggest

A

Hep B infection

acute and chronic

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32
Q

What immunoglobulin is produced first in Hep B

A

anti-HBc IgM

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33
Q

Which immunoglobulin shows you are either cured or vaccinated against Hep B

A

anti-HBs IgG

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34
Q

Which immunoglobulin is produced first in any infection

A

IgM

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35
Q

Which immunoglobulin provides immunity in the long run and has a long life span

36
Q

Which antigen shows you have an active infection of Hep B

37
Q

What is present on Hep B serology of someone who has chronic HBV infection

A

HBsAg

IgG anti-HBcAg

38
Q

What is present on Hep B serology of someone who has an acute HBV infection

A

HBsAg

IgM anti-HBcAg

39
Q

What is present on Hep B serology of someone who has resolved HBV infection

A

IgG anti-HBsAg

IgG anti-HBcAg

40
Q

What is NASH

A

Non-alcoholic steatohepatitis

41
Q

What is the aetiology of NASH

A

Insulin resistance leading to increased triglycerides
which leads to steatosis (fatty changes, organ retention of lipid) which leads to inflammation then finally steatohepatitis

42
Q

What is the triad for NASH

A
  1. RUQ pain
  2. Metabolic syndrome without alcohol use
  3. hepatsplenomegaly
43
Q

What is the investigations for NASH

A
  1. LFT’s (more ALT produced so AST:ALT ratio is less than 1)
  2. metabolic panel and lipid profile
  3. abdominal USS
  4. liver biopsy
44
Q

What is the treatment for NASH

A
  1. correction of lipid and glucose profiles

2. improving diet and exercise

45
Q

What is the triad for alcoholic liver disease

A
  1. RUQ
  2. Associated with heavy alcohol use
  3. hepatosplenomegaly
46
Q

What are the investigations for alcoholic liver disease

A
  1. LFT’s (higher AST: high ALT) ratio of more than 2
    increased GGT
  2. FBC (increased neutrophils and decreased platelets)
  3. U + E’s
  4. Vitamin screening
  5. hepatic ultrasound
47
Q

What is the treatment for alcoholic liver disease

A
  1. Support with alcohol abstinence
  2. Treat metabolic and lipid profile
  3. Steroids
  4. Nutritional support
  5. Liver transplant in liver failure
48
Q

What are the symptoms for cirrhosis

A
  1. abdominal distention
  2. pruritis (itchy skin)
  3. coffee ground vomit
49
Q

What are the clinical signs fro cirrhosis

A
  1. asterixies
  2. dupeytren’s contracture
  3. jaundice
  4. ascites
50
Q

What are the investigations (+ findings) liver cirrhosis

A 
1. LFT's
low albumin 
PT pro-longed
2. Electrolytes, U+E's
Na may be low due to ascites
3. US/CT/MRI 
atrophy/fibrotic nodules
51
Q

A 26 y/o male returns from holiday in India. He has had diarrhoea after eating at a seafood restaurant on his last night. He is feverish and nauseous. You notice that the whites of his eyes are yellow.

A. 	Hepatitis A
B. 	Hepatitis B
C. 	Hepatitis C
D. 	Hepatitis D
E. 	Hepatitis E
A

A. Hepatitis A

52
Q

A 64 y/o male with thalassaemia is investigated under the two-week wait for jaundice and weight loss. His blood tests show a raised αFP. Which chronic infection is he most likely to have?

A. 	Hepatitis A
B. 	Hepatitis B
C. 	Hepatitis C
D. 	Hepatitis D
E. 	Hepatitis E
A

C. Hepatitis C

aFP is a marker for hepatic carcinoma

53
Q

A 32 y/o male returns from holiday in Thailand, feeling ‘under the weather’ with RUQ pain, fevers and nausea. He is jaundiced. He reveals he has used IV drugs and had unprotected sex with a stranger while on holiday. Which test is most likely to give the correct diagnosis?

A. 	Liver function tests
B. 	HIV serology
C. 	Hepatitis B serology
D. 	Hepatitis C PCR
E. 	CXR
A

C. Hepatitis B serology

54
Q

A 43 y/o confused man is brought to A&E by police after being found wandering the streets. He is disorientated and unable to give a clear history. You notice the following in his eyes (Kayser-Fleischer rings). What is he likely to have?

A. 	Alcohol intoxication
B. 	Wilson’s disease
C. 	Opiate overdose
D. 	Haemochromatosis
E. 	Hypoglycaemia
A

B. Wilson’s disease

55
Q

72 y/o man with cirrhosis presents to A&E with diffuse abdominal pain and fever. He is nauseous and has vomited. His abdomen is distended and there is shifting dullness on examination. Which investigation would be most urgent?

A. 	Paracentesis
B. 	Stool sample MC&S
C. 	Abdominal USS
D. 	LFTs
E. 	Blood cultures
A

A. Paracentesis

56
Q

What is the aetiology of gall stones

A

often found in

  1. fat
  2. fair
  3. fertile
  4. females
  5. above forty
  6. often with a FHx
57
Q

What are the symptoms of gall stones

A 
1. RUQ pain 
radiate to shoulder and back 
post prandial (after meals) 
colicky 
2. Nausea
58
Q

What are the signs of gall stones

A
  1. Murphy’s sign: positive sign is when hannd is place in RUQ and patient is asked to breath in, when they do, the pain is worse
  2. Boas sign: pain radiates to the scapula
59
Q

What is the first line investigation for gall stones

60
Q

What is the gold standard investigation for gall stones

A

abdominal ultrasound

61
Q

What is the management for gall stones in the gall bladder (cholelithiasis)

A

cholecystectomy

62
Q

What is the management for gall stones in the common bile duct (choledocholithiasis)

63
Q

What are the complications of gallstones

A
  1. ascending cholangitis

2. acute cholecystitis

64
Q

What is ascending cholangitis

A

Gall stones in the bile duct
leading to bile stasis
the bacteria from the gut moves into the bile ducts

65
Q

What is acute cholecystitis

A

gall stones in the gall bladder

leading to bile stasis, inflammation and bacteria build up

66
Q

What are the sign and symptoms of acute cholecystitis

A 
1. constant RUQ pain 
may radiate to R right scapula (Boas sign) 
2. fever 
3. nausea + vomiting 
4. rebound tenderness 
5. positive Murphys sign
67
Q

What are the signs and symptoms of ascending cholangitis

A 
1. Charcot's triad 
fever
RUQ pain 
jaundice 
If septic: reynold's pentad 
Charcot's triad + hypotension and confusion
68
Q

What is primary biliary cirrhosis

A

An autoimmune condition resulting in damage to (and destruction of) the biliary epithelial cells lining the small intrahepatic bile ducts

69
Q

What are the risk factors for primary biliary cirrhosis

A
  1. peak diagnosis ages 55-65 y/o
  2. females more likely 10:1
  3. other autoimmune diseases
  4. hypocholesteraemia
70
Q

What condition is primary biliary cirrhosis likely to paired with

A

Sjogren’s

71
Q

What are the features of Sjogren’s syndrome

A

dry eyes and mouth

72
Q

What are the signs and symptoms od primary biliary cirrhosis

A
  1. Pruritis (itching of the skin)
  2. fatigue
  3. Sjogren’s
  4. hyperpigmentation
  5. lesions such as xanthomas
73
Q

What is the gold standard investigation for primary biliary cirrhosis

A
  1. AMA (mitochondrial antibodies)
74
Q

What are the investigations for primary biliary cirrhosis

A
  1. LFTs
  2. ASA - diagnostic
  3. Abdomenal US - so that obstructive duct lesion MUST be excluded
75
Q

What is primary sclerosing cholangitis

A

its the inflammation and fibrosis of the intra-hepatic and extra-hepatic bile ducts, resultng in diffuse multi-focal stricture formation

76
Q

What are the risk factors for primary sclerosing cholangitis

A

male gender

IBD

77
Q

What are the signs and symptoms of primary sclerosing cholangitits

A
  1. RUQ pain
  2. prutitis
  3. fatigue
78
Q

What are the investigations for primary sclerosing cholangitis

A 
1. LFTs - first line 
GGT elevated 
2. MRCP - diagnostic
beading 
3. AMA antibodies 
should be negative
79
Q

What is the gold standard investigation for primary sclerosing cholangitis

80
Q

What is pancreatic cancer

A

technically pancreatic ductal adenocarcinoma

81
Q

What are the investigations for pancreatic cancer

A
  1. LFT’s
  2. USS
  3. CT (if suspicious)
82
Q

A 41 y/o female presents with a history of colicky, right sided abdominal pain. She states the pain is worse after eating fish and chips and Indian takeaways. On examination her abdomen is soft and non-tender. Which is the best investigation to confirm her diagnosis?

A. 	Abdominal X-ray
B. 	ERCP
C. 	Liver biopsy
D. 	USS of biliary tree
E. 	CT-KUB
A

D. USS of biliary tree

83
Q

A 41 y/o female presents to A&E with a history of severe, continuous, RUQ pain. She feels feverish and complains of an occasional pain in her right shoulder. On examination she displays RUQ tenderness and a positive Murphy’s sign. What is the most likely diagnosis?

A. 	Biliary colic
B. 	Ascending cholangitis
C. 	Acute cholecystitis
D. 	Primary biliary cirrhosis
E. 	Cholangiocarcinoma
A

C. Acute cholecystitis

84
Q

While waiting to be admitted, her RUQ pain becomes worse and she starts shaking uncontrollably. You notice she now looks jaundiced. What is the most likely diagnosis?

A. 	Biliary colic
B. 	Ascending cholangitis
C. 	Acute cholecystitis
D. 	Primary biliary cirrhosis
E. 	Cholangiocarcinoma
A

B. Ascending cholangitis

85
Q

A 35 y/o man presents with a two week history of jaundice and RUQ pain. He is taking mesalazine for a “bowel condition”. What is the most likely cause of his jaundice?

A. 	Autoimmune hepatitis
B. 	Haemochromatosis
C. 	Primary sclerosing cholangitis
D. 	Primary biliary cirrhosis
E. 	Drug side effect
A

C. Primary sclerosing cholangitis

MedEd Lectures (15 decks)

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